title: D-shape asymmetric and symmetric excision with primary closure in the treatment of sacrococcygeal pilonidal disease.
abstract: BACKGROUND
  Off-midline closure after excision and primary closure in the treatment of sacrococcygeal pilonidal disease has been suggested to improve surgical outcomes and reduce median recurrence rate. The aim of this study was to investigate several features known to be related to recurrence, allowing adequate comparison of recurrence between D-shaped asymmetric and symmetric excision in the treatment of sacrococcygeal pilonidal disease.
  
  
  METHODS
  An analysis of a prospectively maintained database of 569 surgical excisions performed for sacrococcygeal pilonidal disease between 1988 and 2007 was performed.
  
  
  RESULTS
  The recurrence rate was lower in the asymmetric (n = 423) than in the symmetric (n = 101) group (9% vs 22.0%, P = .0001). After a median follow-up period of 11 years, 5-year 10-year, and 20-year disease-free survival rates were higher in the asymmetric group (94%, 92%, and 89% vs 84%, 79%, and 71%, respectively, P = .005).
  
  
  CONCLUSIONS
  D-shaped asymmetric excision is an effective treatment of sacrococcygeal pilonidal sinus. Better long-term recurrence rates are achieved compared with symmetric excision, when stratified for several features known to be related to recurrence.
authors.affiliation: XI Division of General and Obesity Surgery, Master of Coloproctology, Second University of Naples, Via Pansini 5, 80131, Naples, Italy. Electronic address: limpao@libero.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Limongelli
authors.affiliation: XI Division of General and Obesity Surgery, Master of Coloproctology, Second University of Naples, Via Pansini 5, 80131, Naples, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Brusciano
authors.affiliation: XI Division of General and Obesity Surgery, Master of Coloproctology, Second University of Naples, Via Pansini 5, 80131, Naples, Italy.
authors.forename: Crescenzo
authors.initials: C
authors.lastname: Di Stazio
authors.affiliation: XI Division of General and Obesity Surgery, Master of Coloproctology, Second University of Naples, Via Pansini 5, 80131, Naples, Italy.
authors.forename: Gianmattia
authors.initials: G
authors.lastname: del Genio
authors.affiliation: XI Division of General and Obesity Surgery, Master of Coloproctology, Second University of Naples, Via Pansini 5, 80131, Naples, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Tolone
authors.affiliation: XI Division of General and Obesity Surgery, Master of Coloproctology, Second University of Naples, Via Pansini 5, 80131, Naples, Italy.
authors.forename: Francesco S
authors.initials: FS
authors.lastname: Lucido
authors.affiliation: XI Division of General and Obesity Surgery, Master of Coloproctology, Second University of Naples, Via Pansini 5, 80131, Naples, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Amoroso
authors.affiliation: XI Division of General and Obesity Surgery, Master of Coloproctology, Second University of Naples, Via Pansini 5, 80131, Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: D'Alessandro
authors.affiliation: XI Division of General and Obesity Surgery, Master of Coloproctology, Second University of Naples, Via Pansini 5, 80131, Naples, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Docimo
authors.affiliation: XI Division of General and Obesity Surgery, Master of Coloproctology, Second University of Naples, Via Pansini 5, 80131, Naples, Italy.
authors.forename: Ludovico
authors.initials: L
authors.lastname: Docimo
mesh_terms: D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D061646:Operative Time; D010864:Pilonidal Sinus / Q000601:surgery*; D011446:Prospective Studies; D012008:Recurrence; D012445:Sacrococcygeal Region; D013529:Surgical Wound Dehiscence / Q000453:epidemiology; D015996:Survival Rate; D013536:Suture Techniques; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult
keywords: D-shaped asymmetric excision; Sacrococcygeal pilonidal disease; Symmetric excision